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CLINICAL AND SURGICAL APPROACHES TO CHRONIC RHINOSINUSITIS WITH
NASAL POLYPS: AN EVIDENCE-BASED PERSPECTIVE
¹Yazdanov Zafar Nurali o‘g‘li
²Ishkuvatov Kamol Yarmamat o‘g‘li
³Avazov Umrzoq Dilmurod o‘g‘li
¹'²'³Samarkand State Medical University, Department of Otorhinolaryngology No. 2, 1st Year
Clinical Residents
https://doi.org/10.5281/zenodo.15507417
Research Objective
The primary aim of this study is to investigate and compare the clinical, medical, and
surgical management strategies for chronic rhinosinusitis with nasal polyps (CRSwNP), focusing
on patient outcomes, recurrence rates, and quality of life improvements. A secondary objective is
to assess the role of endoscopic sinus surgery (ESS) versus medical therapy in moderate to severe
CRSwNP cases. This study confirms that Chronic Otitis Media with Effusion is a prevalent and
significant cause of hearing impairment in children, which can negatively affect speech
development and overall quality of life if not properly managed. Our findings highlight that timely
diagnosis, aided by thorough clinical and audiological evaluation, is essential for effective
treatment planning.
Both conservative and surgical treatments have distinct roles in managing COME. While
medical therapy may be beneficial in select cases, surgical intervention via tympanostomy tube
placement remains the most effective approach for persistent effusions and hearing restoration.
Importantly, individualized treatment based on patient age, severity, and risk factors
optimizes outcomes.
The research also underscores the importance of long-term monitoring to promptly identify
recurrences and manage complications. Early intervention not only improves auditory function but
also enhances communication skills and social development in children, reducing the risk of
academic and psychosocial difficulties.
In conclusion, multidisciplinary care combining otolaryngological, audiological, and
pediatric expertise is paramount in managing COME, and the establishment of standardized
protocols will contribute to better health outcomes and patient satisfaction.
This study confirms that Chronic Otitis Media with Effusion is a prevalent and significant
cause of hearing impairment in children, which can negatively affect speech development and
overall quality of life if not properly managed. Our findings highlight that timely diagnosis, aided
by thorough clinical and audiological evaluation, is essential for effective treatment planning. Both
conservative and surgical treatments have distinct roles in managing COME. While medical
therapy may be beneficial in select cases, surgical intervention via tympanostomy tube placement
remains the most effective approach for persistent effusions and hearing restoration. Importantly,
individualized treatment based on patient age, severity, and risk factors optimizes outcomes.
The research also underscores the importance of long-term monitoring to promptly identify
recurrences and manage complications. Early intervention not only improves auditory function but
May, 2025-Yil
537
also enhances communication skills and social development in children, reducing the risk of
academic and psychosocial difficulties.
In conclusion, multidisciplinary care combining otolaryngological, audiological, and
pediatric expertise is paramount in managing COME, and the establishment of standardized
protocols will contribute to better health outcomes and patient satisfaction.
Materials and Methods
Study Design:
A prospective observational study was conducted over 12 months at the Samarkand State
Medical University Otorhinolaryngology Department.
Patient Selection
:
A total of 80 adult patients aged 18–65 years diagnosed with CRSwNP were enrolled.
Diagnosis was confirmed based on EPOS 2020 guidelines, using nasal endoscopy and paranasal
sinus CT scans.
Groups
:
Group A (n=40): Treated with medical therapy (intranasal corticosteroids + saline
irrigation + leukotriene antagonists).
Group B (n=40): Underwent Functional Endoscopic Sinus Surgery (FESS) with
postoperative medical therapy.
Data Collection:
a.
Baseline and follow-up evaluations (3, 6, and 12 months)
b.
Sino-Nasal Outcome Test-22 (SNOT-22)
c.
Endoscopic grading (Lund-Kennedy)
d.
CT scores (Lund-Mackay)
e.
Statistical Analysis: SPSS v25.0 software was used. P-values <0.05 were considered
significant. Wilcoxon signed-rank and chi-square tests were applied for comparing pre- and post-
treatment parameters.
Results
a.
Demographics:
b.
Mean age: 41.7 ± 12.4 years
c.
Male/Female ratio: 1.4:1
Group A (Medical Therapy)
a.
Moderate symptomatic relief noted at 3 months (mean SNOT-22 reduction: 18%)
b.
35% showed endoscopic regression of polyps
c.
Recurrence in 40% by 12 months
Group B (Surgical Group):
a.
Significant symptomatic improvement (SNOT-22 score reduction: 56%)
b.
Endoscopic regression in 85% at 6 months
c.
Recurrence rate of 10% at 12 months
d.
Better restoration of nasal airflow and olfaction
Statistical Comparison
:
a.
Significant difference in SNOT-22 improvement (p<0.001)
b.
Lower recurrence and higher satisfaction in surgical group (p=0.003)
Discussion
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538
Chronic rhinosinusitis with nasal polyps remains a challenging clinical condition, often
requiring a multimodal treatment strategy.
This study highlights the relative inefficacy of long-term medical therapy alone in
moderate-to-severe cases, especially in patients with extensive polyp burden.
Endoscopic sinus surgery, when combined with appropriate postoperative care,
significantly improves patient-reported outcomes and minimizes recurrence. The findings align
with global evidence supporting ESS as the preferred modality for patients not responding to
medical treatment alone.
Limitations of our study include a short follow-up period and a relatively small sample size.
Future investigations should assess long-term quality of life, recurrence rates beyond 1 year,
and the role of biologic agents such as dupilumab.
Conclusion
This study demonstrates that while medical therapy may provide transient relief in
CRSwNP patients, surgical intervention via ESS offers superior and more sustained clinical
outcomes. Early identification and timely surgery, followed by guided postoperative care,
significantly enhance treatment success and patient quality of life.
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